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Ppis

Proton pump inhibitors (PPIs) irreversibly inhibit the hydrogen/potassium ATPase enzyme, reducing gastric acid secretion and are indicated for conditions like gastro-oesophageal reflux disease and peptic ulcers. Specific considerations include monitoring for gastric carcinoma and hepatic impairment, while common adverse effects include headache and nausea. Various PPIs like esomeprazole, omeprazole, lansoprazole, pantoprazole, and rabeprazole have specific dosages and formulations for treatment.

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2 views21 pages

Ppis

Proton pump inhibitors (PPIs) irreversibly inhibit the hydrogen/potassium ATPase enzyme, reducing gastric acid secretion and are indicated for conditions like gastro-oesophageal reflux disease and peptic ulcers. Specific considerations include monitoring for gastric carcinoma and hepatic impairment, while common adverse effects include headache and nausea. Various PPIs like esomeprazole, omeprazole, lansoprazole, pantoprazole, and rabeprazole have specific dosages and formulations for treatment.

Uploaded by

fandi alkayed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Proton pump inhibitors

Mode of action
Irreversibly inactivate the hydrogen/potassium ATPase enzyme system (proton pump), suppressing both stimulated
and basal acid secretion. When PPIs are stopped, acid secretion is restored by synthesis of new hydrogen/potassium
ATPase.

Indications
• Gastro-oesophageal reflux disease (GORD)
• H. pylori eradication, as part of an effective regimen treatment of gastric Ulcer
• Prevention of peptic ulcer and short term treatment of upper GI symptoms associated with NSAIDs
• Dyspepsia
• Zollinger–Ellison syndrome
• Scleroderma oesophagus.
Specific considerations

• Gastric carcinoma: exclude before starting treatment for gastric ulcers; PPIs may mask symptoms and delay
diagnosis.
• Hepatic impairment: Risk of accumulation when higher doses are used; monitor for adverse effects; dosage
adjustment not usually required.
• Surgery: Continue treatment perioperatively.
• Pregnancy: Avoid use, ranitidine preferred; ADEC category B3.
• Breastfeeding: Safe to use; all are acid labile; small amount in milk is likely to be destroyed by acid in infant’s
stomach.
Adverse effects

Common: headache, nausea, diarrhoea, abdominal pain, fatigue, dizziness.

Infrequent: rash, itch, flatulence, constipation, decreased absorption of cyanocobalamin (vitamin B12) may occur with
long term use.

Rare: confusion, agitation, aggression, arthralgia, agranulocytosis, PPIs are generally well tolerated. gynaecomastia,
myalgia, interstitial nephritis, raised liver enzymes, hepatitis, jaundice, thrombocytopenia, leucopenia, erythema
multiforme, Stevens–Johnson syndrome, toxic epidermal necrolysis, hypersensitivity reactions.
Esomeprazole

Esomeprazole is the S-isomer of omeprazole

Dosage
GORD
• Initially, oral/IV 20–40 mg once daily; change from IV to oral treatment as soon as possible.
• Maintenance, reduce to minimum required.

H. pylori eradication
• Oral, 20 mg twice daily for 1 week, with 2 antibiotics.

NSAID-associated upper GI symptoms


• Oral, 20 mg once daily for 4 weeks.

Prevention of NSAID-associated peptic ulcer


• Oral, 20 mg once daily.
Swallow tablet whole; do not crush or chew. Alternatively, the tablet may be dispersed in
water and taken within 30 minutes.

Esomeprazole tablets may be dispersed in water and taken within 30 minutes.


Products
• Sachets 10 MG
• TABS 20 MG
• TABS 40 MG
• VIAL 40 MG
(NEXIUM®, PUMPINOX®)
Omeprazole
Dosage

PUD: Initially, oral 20–40 mg once daily for 4–8 weeks (gastric ulcer). Maintenance, oral 20 mg once daily.

GORD: Initially, oral 20–40 mg once daily (up to 80 mg daily can be used). Maintenance, reduce to minimum required.

Zollinger–Ellison syndrome: Adjust dose according to gastric acid output. Initially, 60 mg once daily.. Maintenance,
oral 20–120 mg daily (give doses >80 mg daily as 2 divided doses).

H. pylori eradication: Oral, 20 mg twice daily for 1 week, with 2 antibiotics.

NSAID-associated PUD or erosion: Treatment, oral 20–40 mg once daily for 4–8 weeks. Prophylaxis, oral 20 mg once daily.

Child: <10 kg, 5 mg once daily.


10–20 kg, 10 mg once daily (maximum 20 mg/day).
>20 kg, 20 mg once daily (maximum 40 mg/day).
Products

• TABS OR CAPS (20 MG OR 10 MG)

• VIAL 40 MG
HYPOSEC®
GASEC®
LOPRAZ®
LOSEC®
ODASOL®
OMEDAR®
OMEPREX®
OMISEC®
OPRAZOLE®
RISEK®
RYTHMOGASTRY®
OMEPREX®
Lansoprazole
Dosage

PUD: Initially, 30 mg once daily for 4–8 weeks. Maintenance, 15–30 mg once daily.

GORD: Adult, initially, 30 mg once or twice daily. Maintenance, reduce to minimum required.
Child >1 year
<30 kg, 15 mg once daily for 8–12 weeks (maximum 30 mg twice daily).
>30 kg, 30 mg once daily for 8–12 weeks (maximum 30 mg twice daily).

Dyspepsia: Initially, 15–30 mg daily for 4–8 weeks.

Zollinger–Ellison syndrome: Adjust dose according to gastric acid output. Initially, 60 mg once daily. Maintenance,
30–180 mg daily (give doses >120 mg daily as 2 divided doses).

H. pylori eradication: 30 mg twice daily for 1 week, with 2 antibiotics.

Severe hepatic impairment: Maximum recommended dose 30 mg daily.


Patient counselling
Swallow capsule whole; do not crush or chew. Alternatively, the capsule may be opened and the contents dispersed
in apple, orange or tomato juice, yoghurt or apple sauce; take immediately.
Add the granules to 30 mL of water, stir well and drink immediately.
Products
• CAPS/TABS 15 MG
• CAPS/TABS 30 MG
LANSAZOL®
LANSOMID®
LANZOTEC®
LANZOPRAL®
LANZOR®
LAZAL®
PEPTAZOLE®
TAKEPRON®
ULTRAZOLE®
PANTOPRAZOLE

Dosage
PUD: Initially, oral/IV 40 mg once daily for 4–8 weeks; change from IV to oral treatment as soon as possible.
GORD: Initially, oral 40 mg once or twice daily; IV 20–40 mg daily (change to oral treatment as soon as possible).
Maintenance, reduce to minimum required.
Prevention of NSAID-associated dyspepsia, PUD or erosion: Oral, 20 mg once daily.
Zollinger–Ellison syndrome: Adjust dose according to gastric acid output. Usually 80–120 mg oral twice daily or
80 mg 3 times daily.
H. pylori eradication:
Oral, 40 mg twice daily for 1 week, with 2 antibiotics.
Patient counselling
Swallow tablet whole; do not crush or chew.
Products
TABS 40 MG

• CONTROLOC®
• PANTODAR®
• PANTOLOC®
• PANTOVER®
• PROTON®
• RAZON®
Rabeprazole

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